Provider Demographics
NPI:1093069718
Name:FILIPPINI, MARY JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:FILIPPINI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1810
Mailing Address - Country:US
Mailing Address - Phone:773-777-6507
Mailing Address - Fax:773-777-2791
Practice Address - Street 1:4228 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1810
Practice Address - Country:US
Practice Address - Phone:773-777-6507
Practice Address - Fax:773-777-2791
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190197131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice